ObjectiveTo evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. MethodsThe clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. ResultsA total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm2, the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm2. Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. ConclusionFrom the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.